Patients can manage heart failure treatment safely at home, according to the results of a major UK-wide trial that could transform how the condition is managed and ease pressure on the NHS. The study, known as the SUBCUT HF II trial, involved 172 heart failure patients and was led by the University of Glasgow Heart Failure Clinical Trial Team. It found that patients who were given a wearable mini-pump to deliver a powerful diuretic at home were discharged from hospital after around two days – five days earlier than the typical UK stay – and were no more likely to become unwell than those receiving standard care. Their recovery rates were also comparable.
How patients administer their own treatment
The device at the centre of the trial is a wearable mini-pump, similar in concept to the insulin pumps used by people with diabetes. It is designed to deliver furosemide, a loop diuretic commonly given intravenously in hospital when oral tablets are not enough to control the fluid build-up that characterises worsening heart failure. The medication is infused through a small needle placed under the patient’s skin, and the pump can be worn discreetly on the body. Patients who used the device described it as painless and non-intrusive. One participant in the trial told researchers they had forgotten the device was attached after just 10 to 15 minutes, found it easy to use, and said it allowed them to return home to their family and be more comfortable. The device, called the SQin-pump, was developed by SQ Innovation Inc.
The trial team, working with NHS Greater Glasgow and Clyde’s Research Innovation and Pharmacy Teams, selected patients who were experiencing acute exacerbations of heart failure and would normally require hospitalisation for several days of intravenous diuretics. Current routine treatment for such episodes typically lasts nine to ten days. By shifting that care to the home, the study demonstrated that patients themselves could safely manage the administration of the medication after a short period of training. The approach is part of a broader shift towards remote monitoring and patient empowerment, which health officials see as essential to reducing the burden on hospital beds. Heart failure accounts for a substantial number of inpatient bed days in the NHS each year.
Broader innovations in heart failure care
The wearable pump is one of several technological developments aimed at improving outcomes for the roughly one million people in the UK living with heart failure, an incurable condition in which the heart cannot pump blood efficiently. More than half of patients die within five years of diagnosis, a prognosis that is often compared unfavourably to many cancers. Diagnosis is frequently made late, after a hospital admission when the disease is already severe. To address this, researchers at the University of Glasgow are also exploring the use of artificial intelligence to interpret echocardiogram images from handheld devices, which could slash waiting times for diagnosis. Dr Ross Campbell, a clinical senior lecturer at the University of Glasgow and consultant cardiologist at the Queen Elizabeth University Hospital, who is a co-lead author of the SUBCUT HF II study, is involved in that AI work too.
Other innovations include the Sensinel Cardiopulmonary Management System, a non-invasive wearable sensor being trialled to detect fluid overload early and potentially prevent hospital admissions. The National Institute for Health and Care Excellence (NICE) has already recommended algorithm-based technologies such as HeartLogic and TriageHF, which work with implantable cardiac devices to identify worsening heart failure and reduce hospitalisations. Separately, a study from the University of Birmingham found that consumer wearable devices like smartwatches could provide clinically useful information when comparing treatment responses in patients with atrial fibrillation and heart failure. In Scotland, ECG patch monitors are being rolled out nationally to speed up the diagnosis of atrial fibrillation, a condition linked to stroke. A global trial called Strong-HF also showed that a “rapid titration” approach to heart failure medication – giving larger doses early – cut deaths by 62% and hospitalisations by 30%.
Study results and researcher’s verdict
The SUBCUT HF II trial, which was conducted across multiple sites in the UK including the Queen Elizabeth University Hospital in Glasgow, enrolled patients who were then randomised either to receive standard hospital-based intravenous diuretic therapy or to go home with the wearable pump. Those in the device arm were discharged after a median of two days and completed their treatment at home, with clinical staff providing remote support. The findings confirmed that the combination of the mini-pump and furosemide was safe and effective: patients on the device arm were no more likely to become unwell again after treatment and showed similar recovery rates to those who remained in hospital. The University of Glasgow’s School of Cardiovascular & Metabolic Health, which has a history of testing effective heart failure drugs and advocating for specialist heart failure nurses, coordinated the trial.
Dr Ross Campbell, clinical senior lecturer at the University of Glasgow and consultant cardiologist at the Queen Elizabeth University Hospital, co-lead author of the study, said: “This study has shown that we can successfully and safely manage patients with heart failure in their own home and, moreover, that patients are able to administer treatment themselves.”
